Sexual Risk Reduction
Although it is recommended that providers routinely assess their HIV-infected patients for sexual risk behaviors, many providers conduct sexual histories of their patients inconsistently, particularly patients who present without genitourinary complaints.
Young people living with HIV need access to accurate information about HIV and STI transmission to address their concerns about sexuality, dating, disclosure, and transmission risk, and to answer their questions about parenting--and this information should be culturally and linguistically appropriate. In general, they want their health care providers to provide that information and to sensitively ask them personal questions about HIV-related risk behaviors. Although they want these discussions to take place, most youth prefer that providers initiate the discussion.
Among many AA/PI families, males have a higher status than females and older family members have a higher status than younger members.45 When providers meet with family members, it may be tempting to address younger, more Americanized family members, rather than elderly members who do not speak English. If questions are not directed toward the person who has the power to make decisions, the entire family could be insulted and confusion could arise. However, involvement of the patient's family may or may not be appropriate. After an assessment, and when appropriate for the patient's care, the provider should work within the traditional family hierarchy. To correctly identify the head of the family, providers may consult first with the patient.414
Among Blacks/African Americans, family is not defined solely by blood relationship. Often non-blood kin 15 are as influential in an adolescent's life as blood relatives. Adolescent may have been reared by relatives other than their parents or non-blood relatives. This is particularly likely among adolescents with perinatally acquired HIV infection whose parents have died. It may be useful for providers to construct genograms with their patients and identify people the adolescent trusts to help them make decisions. It is important to get a sense of who the adolescent defines as family. From here the provider can take to appropriate steps to involve parents, guardians, and significant family members in discussions about sexuality. These adults may prefer separate sessions with the provider to help them find the words they need to discuss sexuality and safer sex with their teenagers.
In order for these discussions to be effective, patients must feel that their providers will comfortably and supportively engage in dialogue with them about any topic--no matter how risqué or risky that may be. Young people can sense when providers are out of their element discussing sensitive issues and this perception will almost certainly hinder honest communication about risk behaviors. Patients also can be keenly aware of the cultural biases and perspectives of the providers and feel that they do not really understand their community or family contexts. Providers who are uncomfortable talking about sex or drugs, and those who may be reluctant to face their own potential cultural biases, should practice talking about these issues before they initiate risk-reduction discussions with their patients.
- Chodon T. The Role of Culture in HIV/AIDS Health Care -- A Practical Guide for Providers Serving Asian and Pacific Islander Americans. New York, NY: Asian & Pacific Islander Coalition on HIV/AIDS, Inc. 2001.
- Galanti, G. Caring for Patients from Different Cultures, 2nd edition. Philadelphia: University of Pennsylvania Press. 1997.
- Fadiman, A. The Spirit Catches You and You Fall Down. A Hmong Child, Her American Doctors, and the Collision of Two Cultures. Farrar, Straus and Giroux: New York. 1997.
- Boyd-Franklin N. Black Families in Therapy: A Multisystems Approach. New York: Guilford; 1989.